Monday, February 18, 2008

Last November, eight-year Army veteran Sgt. Brad Gaskins was arrested for going AWOL from Fort Drum, New York. He'd served one peacekeeping tour in Kosovo and two tours in Iraq, having problems with flashbacks, nightmares, headaches, sleeplessness, weight loss and aggressive mood swings after returning from the second Iraq tour.

At the time of his arrest, AP reported:

...Gaskins said he left the base in August 2006 because the Army wasn't providing effective treatment after he was diagnosed with PTSD and severe depression. "They just don't have the resources to handle it, but that's not my fault," Gaskins said.

Over the past decade, Fort Drum’s 10th Mountain Division has been one of the Army’s most heavily deployed divisions. Since September 11, 2001, Fort Drum’s 2nd Brigade Combat Team (BCT) is the most deployed brigade in the Army – with more than 40 months logged away from home in that time.

VFA’s new report [details :: download pdf] highlights the lack of treatment available to combat Soldiers and presents potential solutions to what the Pentagon acknowledges is a “daunting and growing” problem.

“Sooner or later, and likely sooner, we’re going to hit the wall and something will have to change,” said Bobby Muller, VFA’s founder. “Simple morality and decency demand a change. We cannot continue taking such gross advantage of those who have offered themselves in service to our country.”

On their latest Iraq tour, members of the 2nd BCT were more than five times more likely to have been killed than others who have been deployed to Iraq and Afghanistan and more than four times as likely to have been wounded. In all, the 2nd BCT has been deployed four times. Pentagon studies have found that a Soldier’s chance of developing mental health problems increases 60 percent upon each deployment.

“Soldiers at Fort Drum have been repeatedly exposed to high intensity combat. Mental health resources must match this level of sacrifice,” said Jason W. Forrester, one of the report authors.

Multiple Soldiers at Fort Drum informed VFA of low morale on base and rising DUI and AWOL rates. Even when Soldiers had the courage to seek mental health treatment, they often waited as long as two months for appointments with on-base mental health professionals.

From the Introduction:

Soldiers from Fort Drum are bearing a disproportionate burden of the costs of our wars in Iraq and Afghanistan. Unfortunately, the mental health care system at Fort Drum is not meeting the demands of this burden.

Of all U.S. Army divisions, the 10th Mountain Division, based at Fort Drum, New York, has been the most affected by our country’s crushing recent deployment cycle. Since September 11, 2001, the 2nd Brigade Combat Team (BCT)1 is the most deployed brigade in the Army, having recently completed its fourth tour (the Appendix contains the 2nd BCT’s post-9/11 deployment history). In all, the 2nd BCT has been deployed for more than 40 months since 9/11.2 Compounding the difficulties facing members of the 2nd BCT is the Army-wide problem of inadequate dwell time (i.e., the time between deployments to readjust, rest, retrain, reconstitute, visit family and friends, and integrate new unit members).

None of the 2nd BCT’s three dwell periods has risen to the Army’s traditional goal of a 2:1 dwell time to deployed time ratio for active Army units. One of the dwell periods for the 2nd BCT was only six months, after having been deployed to Afghanistan for eight months and before being deployed to Iraq for another 12 months. Fortunately, Army leadership—most notably General George Casey, Jr., the current Chief of Staff of the Army—has been vocal in stating that the problem of inadequate dwell time must be fixed. In his words: “…it’s so important to extend the time that they [Soldiers] spend at home… [Current deployment policies are] not something that we can sustain over time, and that’s one of the key elements of putting ourselves back in balance, to get to 18 months or so dwell [time]…”3

Further complicating the challenges facing members of the 2nd BCT is the regrettable decision, announced in April 2007 by Secretary of Defense Robert Gates, to extend Army tours in Iraq from 12 to 15 months. Soldiers from the 2nd BCT noted the greatly dispiriting effect of this policy shift, which was announced shortly after the BCT had passed what it assumed was its half-way deployment mark. Mental health experts have informed Veterans for America (VFA) that “shifting the goalposts” on a Soldier’s deployment period greatly contributes to an increase in mental health problems within units.

Finally, the intensity of the combat experienced by the 2nd BCT is remarkable. During its most recent deployment, 52 members of the 2nd BCT were killed in action (KIA), 270 others were listed as non-fatality casualties, and two members of the unit remain missing in action (MIA). When compared to all who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), the intensity of combat for the 2nd BCT is quite clear. On their most recent deployment, members of the 2nd BCT were more than five times as likely to be killed as others who have been deployed to OEF and OIF and more than four times likely to be wounded.

This level of combat will bring with it considerably higher rates of mental health challenges for members of the 2nd BCT than other units that have served in OEF and OIF and will merit considerably closer attention by Army and Pentagon leadership to reduce the likelihood that these Soldiers are failed by the already-overburdened mental health treatment system.

The 1st BCT of the 10th Mountain Division is also among the most deployed Army brigades. Being heavily deployed is nothing new...

The four tours in Iraq served by the Second Brigade at Fort Drum here have created an unusual level of stress, especially after the standard Iraq tour was increased to 15 months from 12. Yet according to a new report on the shortcomings of mental health care at the base, a soldier’s wait to be seen for psychological help can take more than a month.

The draft report, “Fort Drum: A Great Burden, Inadequate Assistance,” which was given to The New York Times last week, was done by Veterans for America, a nonprofit advocacy organization for wounded members of the armed forces. It also uncovered several other problems with the mental health services on the post, which is north of Syracuse.

Based on interviews with a dozen soldiers and the mental health providers on the base, the report describes problems with understaffing, a reliance on questionnaires to identify soldiers in need of treatment and a sometimes dismissive view at the company level of post-traumatic stress disorder.

“The system is very much overburdened,” said Jason W. Forrester, director of policy for Veterans for America, in a telephone interview last week. “These problems are going to continue as long as we have units, such as the Second Brigade Combat Team, that have seen high-intensity combat, extended deployments and inadequate time between deployments.” ...

the report said that the wait for an appointment has eased since three Army psychiatrists were reassigned last month from Walter Reed Army Medical Center, joining three psychiatrists already on the base, to address the needs of 3,500 Second Brigade soldiers recently back from Iraq. But, the report noted, the reassignment was “only a temporary fix” since the psychiatrists from Walter Reed would probably return to Washington in a few weeks.

Fort Drum lacks its own hospital, so any soldier needing inpatient treatment has to be sent to Samaritan Medical Center in Watertown, which recently increased the number of beds in its psychiatric unit to 32 from 24.

But the report said that when the psychological facilities at the base have closed for the day, some soldiers have bypassed Samaritan and driven more than an hour to Syracuse for treatment. The Veterans for America report said the soldiers fear that doctors at Samaritan will side with some base leaders, who had, “in some cases, cast doubt on the legitimacy of combat-related mental health wounds.”

“The Department of Defense itself has recognized that with every tour you increase the likelihood of post-traumatic stress disorder,” said Adrienne Willis, spokeswoman for Veterans for America. “Here we have a brigade that has served four tours.”

Nor is the heavy service the only problem at Fort Drum. In the last two weeks, it has been at the center of a controversy over whether the Army instructed the Department of Veterans Affairs last March to stop helping soldiers there with their disability claims. At first, the Army surgeon general, Eric B. Schoomaker, denied that the Army had told Veterans Affairs to do so.

But after National Public Radio reported on a memorandum from the March meeting in Buffalo in which a colonel was quoted as directing Veterans Affairs to discontinue counseling, the surgeon general apologized for his denial and said it was based on a “miscommunication.”

Army officials in upstate New York instructed representatives from the Department of Veterans Affairs not to help disabled soldiers at Fort Drum Army base with their military disability paperwork last year. That paperwork can be crucial because it helps determine whether soldiers will get annual disability payments and health care after they're discharged.

Now soldiers at Fort Drum say they feel betrayed by the institutions that are supposed to support them. The soldiers want to know why the Army would want to stop them from getting help with their disability paperwork and why the VA— whose mission is to help veterans — would agree to the Army's request.

'A Worn Pair of Boots'

One disabled soldier, who spoke on the condition of anonymity because he fears retaliation from the military, says it feels like a slap in the face.

"To be tossed aside like a worn-out pair of boots is pretty disheartening," the soldier says. "I always believed the Army would take care of me if I did the best I could, and I've done that."

At a restaurant near Fort Drum, the soldier described his first briefing with the VA office on base. According to the soldier, the VA official told a classroom full of injured troops, "We cannot help you review the narrative summaries of your medical problems." The official said the VA used to help soldiers with the paperwork, but Army officials saw soldiers from Fort Drum getting higher disability ratings with the VA's help than soldiers from other bases. The Army told the VA to stop helping Fort Drum soldiers describe their army injuries, and the VA did as it was told.

It's unclear why the Army wanted to stop the soldiers from getting help with the disability paperwork. Cynthia Vaughan, spokeswoman for the Army surgeon general, says the VA was not doing anything wrong by helping soldiers at Fort Drum.

"There is no Army policy on outside help in reviewing and/or assisting soldiers in rewriting their narratives during the 10-day period which they have to review them," Vaughan says.

She says the officers who asked the VA to stop helping Fort Drum's soldiers were part of what the Army calls a "Tiger Team"— an ad-hoc group assigned to investigate, in this case, medical disability benefits.

According to Army spokesman George Wright, the Tiger Team thought the VA should not be helping soldiers with their medical documents. The Army delivered that message to VA officials in Buffalo, N.Y., who went along with the request, even though the VA's assistance complied with Army policy.

The Army declined to provide any information about the Tiger Team members' identities or their motivations in asking the VA to stop reviewing the soldiers' paperwork. However, private attorney Mara Hurwitt points out that the Army has a financial incentive to keep soldiers' disability ratings low.

"The more soldiers you have who get disability retirements, the more retirement pay is coming out of your budget," Hurwitt says.

Qualified to Help?

Another question is why the VA would go along with the Army's request.

Tom Pamperin, deputy director of the VA's compensation and pension service, believes VA officers are not qualified to help with soldiers' disability paperwork.

"We do not train our employees in the intricacies of the Defense Department's disability evaluation system, so we would feel that it would be inappropriate for our employees to apply VA standards to a Defense Department process," Pamperin says.

But Hurwitt argues the VA is more equipped than anyone to help soldiers with their paperwork. "VA counselors understand the disabilities, what the different kinds of conditions are, how they should be properly described in the paperwork," Hurwitt says.

She points out that VA officials have to look at a soldier's medical history anyway to counsel him or her on VA benefits, which are separate from Army benefits.

"Really what it comes down to is you're just helping the soldier get what he's entitled to under law," Hurwitt says.

On the memo that bolstered NPR's position after the Army denied the veracity of its report:

A document from the Department of Veterans Affairs contradicts an assertion made by the Army surgeon general that his office did not tell VA officials to stop helping injured soldiers with their military disability paperwork at a New York Army post. ...

The day the NPR story aired, Army Surgeon General Eric B. Schoomaker denied parts of the report. Rep. John McHugh (R-NY), who represents the Fort Drum area, told North Country Public Radio, that "The Surgeon General of the Army told me very flatly that it was not the Army that told the VA to stop this help."

Now, NPR has obtained a four-page VA document that contradicts the surgeon general's statement to McHugh. It was written by one of the VA officials at Fort Drum on March 31, the day after the meeting. The document says Col. Becky Baker of the Army Surgeon General's office told the VA to discontinue counseling soldiers on the appropriateness of Defense Department ratings because "there exists a conflict of interest."

When contacted by NPR, Baker referred an interview request to the Army Surgeon General's spokeswoman. The spokeswoman rejected requests for interviews with Baker and Schoomaker.

The document says that before the Army team's visit, people from the Army Inspector General's office came to Fort Drum and told the VA it was providing a useful service to soldiers by reviewing their disability paperwork.

According to the document, joining Baker on the Army team at the Fort Drum meeting was Dr. Alan Janusziewicz. He retired as deputy assistant surgeon general for the Army in October.

"I was part of the team, and I was probably instrumental in the surgeon general denying that the Army had instructed the VA" to stop reviewing soldiers' Army medical documents, Janusziewicz told NPR in a phone interview.

Meanwhile, while the Army goes back and forth trying to cover its own behind, its soldiers continue to spiral downward at an ever-increasing rate. Two recent cases:

A 29-year-old soldier from Louisiana was found dead in his barracks at Fort Drum. Officials at the northern New York Army post said Spc. Lawrence Holloway was healthcare specialist assigned to the 3rd Battalion, 85th Infantry Regiment. He was found dead in his barracks room shortly after noon on Sunday.

On Wednesday, Benjamin Abel, the post's media relations officer, said autopsy results have not been released. He said the investigation is continuing.

A native of Ponchatoula, La., Holloway joined the Army in February 2004 and completed basic training at Fort Knox, Ky., before receiving advanced individual training at Fort Sam Houston, Texas. In Afghanistan from February 2006 to January 2007, he served as a medic and ambulance driver with the 10th Sustainment Brigade.

On February 9, 2008, Fort Drum was back in the news when an Afghanistan veteran was killed by police responding to his residence following an apparent domestic dispute:

Officials say the Army is conducting a full-scale investigation into the killing of a Fort Drum soldier by military police.

The incident happened early Saturday after Fort Drum emergency services received a hang-up call from an on-post residence. Two officers went to the home and talked to Staff Sergeant Dustin McMillen and his wife.

Tenth Mountain Division spokesman Lieutenant Colonel Paul Swiergosz says things took a drastic turn when McMillen pulled out a concealed non-military handgun. He says a second group of officers tried to get McMillen to surrender, and McMillen fired two shots in the direction of the officers.

1 of the officers shot McMillen, who later died at a Watertown hospital.

While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety.
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Considerable Quotes

"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes

"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell

"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress

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